Kitties Aren't Supposed To Be Yellow

So when Snaps came to see us and we saw the very bright discoloration of her skin, gums, ears-even what should have been the "whites" of her eyes, well, we knew there was something serious going on.

Her owners said Snaps just wasn't herself. She had vomited a few times, but really wasn't eating well and the once very obese cat now just looked moderately overweight-a very dramatic and rapid weight loss for her. Her owners knew something was wrong, but hadn't realized their kitty was practically glowing in the dark.

Jaundice or icterus is the name of this whole body yellowing, resulting from a yellow pigment, bilirubin, normally kept in check by the liver. Diseases of the liver, of course, can result in this icterus, but so can primary diseases of the biliary system itself-the gall bladder or bile ducts. Other less common causes include hemolytic anemias, where red blood cells are destroyed, often by the body's own immune system. Snap's blood tests led us in the direction of her gall bladder-her liver and red blood cells seemed to be just fine.

You have probably heard of bile ducts but may not really be sure what bile is all about. Bile is a greenish material the liver makes, then transports to the gall bladder via small bile ducts. The gall bladder is a small greenish sac about the size of a large cherry in a cat where bile is stored. When the appropriate hormonal signals are present, the gall bladder contracts and squirts bile into the small intestine via one very large duct called the common bile duct.

Bile has several functions. It emulsifies the fat in our diets so that we can absorb it into our bodies. It also serves as a medium to dump toxins that the liver has removed and processed from our bodies. Mixed and bonded in bile salts, these cannot be reabsorbed from the intestine back into the body and are harmlessly excreted in feces.

Diseases of the gall bladder can be infectious, usually bacterial or neoplastic (cancerous) especially in older patients. We also see mechanical problems with the biliary system-sludging or thickening of the contents (bile) or even gall stones blocking passage of the bile through the bile ducts. These can be very painful conditions, and often cause anorexia because every time the patient goes to eat the gall bladder contracts to empty its contents into the small intestine to aid in digestion. If there is a blockage or infection/inflammation, contraction produces pain- the cat will associate eating with pain, so will simply stop eating to avoid that pain.

Now, one would think that weight loss in an obese cat would be a good thing. But cats are difficult creatures, for sure. As obligate carnivores, they require protein daily. If they aren't ingesting it, they will find it somewhere-even utilizing their own liver tissue as a source of that protein. The body will use the liver cells and replace these hepatocytes with adipose or fat cells causing a very serious condition called hepatic lipidosis or "fatty liver disease." Sometimes this is actually the primary disease, but usually there is some reason that the cat stopped eating well.

Since Snaps was essentially starving herself, we anesthetized her and placed a stomach feeding tube. This made it much easier for us and her owners to syringe feed her calculated needed calories each day (rather than trying to do so by mouth and having more of the food end up ON her rather than IN her!) It was also a good way to give her medications-just mixing those pills and capsules with liquids and foods and putting them directly in the tube rather than fighting her for that, too. We prescribed a long course of antibiotics and antimicrobials as well as anti-nausea medication and pain relief drugs. She was also given a whole bunch of fluids under her skin to help start flushing her liver of those built up toxins and pigments. Snaps was also started on a type of medication known as a "cholorectic." Ursodiol or actigal is this medication that makes bile more liquid so that it can flow smoothly without sludging. Flow of bile in the proper direction helps remove not only the toxins the liver is trying to remove in bile but also helps prevent bacteria from swimming upstream towards the liver tissue. We were hoping that her bile ducts were not actually blocked or that Snaps did not have gall stones present as cholorectic drugs would not work for these issues-surgery would be her only option in those cases.

So, Snaps was sent home with a whole lot of nursing care expected of her very devoted owners. They did a fabulous job with her-at one point it even looked like she was less jaundiced and had even gained some weight. But Snaps never did begin eating on her own, and it wasn't long before she began to vomit the food her owners gave in the tube if they tried to give any more than just a minimal amount. It wasn't enough to maintain her weight any longer, and she started getting more yellow by the day. She was licking her lips and acting nauseous if she even saw her owners approach her with food. I strongly suspected a biliary duct blockage or gallstones, but would need an ultrasound exam to be sure.

We referred Snaps' owners to a veterinary internal medicine specialist for that procedure. Unfortunately, their costs were estimated to be quite high, as was to be expected of such a specialized procedure with biopsies and lab reports involved. I had scanned many abdomens but was far from an expert, so offered my services for free just to visualize the gall bladder and liver only and determine the presence or absence of gallstones or big dilated biliray ducts-signs indicating likely blockages. Snaps' owners were very grateful, and it did give me more experience with this procedure.

Well, the ultrasound scan was pretty quick and easy-a homogenic (even throughout) liver-no obvious masses or other defects with a very large gall bladder and hyperechoic (very bright white) structures in the lumen. (center) Snaps has gallstones. No amount of medications will fix these-she has to have surgery to relieve the pain felt every time the organ contracts down on those stones each time she eats (or is tube fed for that matter.) What a horrible situation that must be-to be in pain just because of a basic need and a generally pleasurable function-eating.

We have talked with her owners and will try to come up with a plan for her. While referral to a veterinary surgeon is highly recommended for a cholocystectomy, (gall bladder removal) money of course is a big factor. We might be able to use some funds from our Flake's Angel Fund if the owner can match those funds and attempt to do this surgery ourselves. I have done a few others-it is a very difficult surgery but am hoping to get some tips for better visualization (I have found this to be the key to this surgery) from the veterinary surgeons we work with. They are very helpful that way.

Snaps' owners are saving up their money deciding what they want to do (and what they are able to do.) In the mean time they will continue to try to get food into her, even if it is just small amounts very frequently. Her liver medications aren't as important, but her pain relief meds certainly are.

I'll try to post some pictures of her surgery when/if we get to do it. She is a great kitty and she has very nice owners who are doing a great job with her care. Not all owners would be this devoted, that's for sure.

I felt so bad neglecting my blog this long-it is good to be back!

Peace,
DrReneigh

A Dream Come True

Literally. Ever since I was very young, whenever we would go camping or backpacking and I would see the tell-tale hoof prints of the horses who had traveled along that trail, I imagined and dreamed of one day being the lucky one camping with her horse. And seeing horses galloping on the beach-ah, so majestic and beautiful. I have been a beach lifeguard and a lifelong sun worshiper. I have had opportunities to ride on a beach with rental horses in Mexico and on the central California coast, but never with my own horse. That is, until last weekend. I joined a group on Meetup.com of fellow horse lovers, and due to the generosity of some folks who offered to haul my big horse, took off a couple days (which I NEVER do!) and went to the Oregon coast to go horse camping! We planned for months (having to reserve space for 40 people and horses) and I almost died when my mare came up lame the night before the trip (could only happen to a vet's horse, right?) She got a stone bruise but a little iodine, bute and lots of adrenalin (and a gigantic epsom salt soak in that ocean!) and she was good to go... but not after I said a hundred prayers and cried myself to sleep. Well, the weather was perfect, she never limped a single step, the people were fun, and, well, the pictures say it all. I got to go camping with and ride MY gorgeous horse on the beach-and made it before I turned 50!

I was originally supposed to go with a fellow horsey friend, but she backed out a couple of weeks ago. I still had to go, of course, but was thinking it wouldn't be as much fun not really knowing anyone. When my other friend, Happy, heard I was going alone, she casually invited herself to come along-and boy am I glad she did! She is totally un-horsey, in fact, she has never even rode a horse in her life. But she was my biggest cheerleader-really understanding what this weekend meant to me and being a true friend in every sense of the word. She helped out planning our meals and shopping before hand for gear and supplies. Happy was a great companion for the long road trip, putting up with my choice of "old man rock" music and just gabbing with me during the drive. Once we arrived at the campground, she helped so much setting up the tent and kitchen stuff and all while I got Raquel all situated. And boy did she take some great pictures! I don't have many of her, darn it, since she was the one behind the camera lens, but I will never forget all she did for me and Raquel during our adventure.

Raquel settled into her camp stall just fine. I had been a bit worried that she would power through the chain gate (we have electric fences at home for just that reason) but putting a constant supply of hay in front of her (and keeping her good and tired from all the beach rides) did the trick. Our organizer had recommended to bring one of those pop up canopies to put over the stall so the horses wouldn't have to stand in the direct sun all day (or pouring rain if that was the case.) The horse camp sites were so much better than the regular sites. We had a lot more privacy, not just parked right on top of each other. It was still early in the season so it wasn't crowded at all, but I bet it can get pretty packed in the middle of summer.

A group of us decided to walk our horses out to the beach on foot that first evening-just to give them a "taste" of the salt air, all the sights and sounds and smells and all. I'm glad we did. Raquel was snorting and prancing and dancing-everything was new and exciting. Happy's pictures sure captured the moment. Later on we joined the bigger group for a potluck supper and get-together. Good food and good company. Happy even found that she knew some of the folks from high school if you can believe that! Such a small world. We were pretty tired from all the excitement of a very full day, so turned in soon after dark.

Friday morning we woke up early-well, I don't think Happy and I slept much, actually. We had left the tent flap open a bit and ended up getting pretty wet and cold from all the dew and condensation. It just felt better to get out of the wet sleeping bags and get some hot coffee into us. And I was just itching for that first ride on the beach! I decided to give Raquel some bute (phenylbutazone, a nonsteroidal antiinflammatory drug) for a bit of swelling in the fetlock of the leg with the bruised hoof. That went over well-NOT! She knows just how tall she is, and how short I am! Oh well, she got the meds after a little fight, then off to the beach we went. I went out with a sweet lady named Deb and her older horse, Todd. She wanted to take it slow and easy-just right for our first time. I didn't need a rodeo! We rode over the dunes and out onto the beach and there we were! It was incredible. Raquel continued to dance and prance as she took in all the smells and the sounds of the waves and all. It took awhile, but she eventually splashed through the water when she figured out it wouldn't eat horses. After I felt she had most of the bugs out of her system, we went ahead and took our first run on the beach. What a feeling that was! She never took a lame step, we had the wind in our hair and sun on our faces. Back home Raquel is usually last on trail rides with me legging her on-not on the beach. There she was always wanting to be in the lead, fighting the bit to go, go, go! I think she felt so much more sure of herself there, more balanced where she didn't have to worry about turning every 2 or 3 strides as she does in the arena back home. It filled my heart to see her having so much fun.

My sister Kristine and her partner Kelly had just had their first baby a week before this trip. Since they live in Oregon, I thought I would take the opportunity to go visit since I was so close. I asked my camp neighbors to peek in on Raquel through the day if they could, making sure she had food and water and off we went. Well, it wasn't all that close, what with windy roads, a bad accident on one highway, and Friday afternoon commuter traffic. But I am so glad Happy and I made the trek. Little Aven is just beautiful, and Kristine and Kelly are terrific mommas. The visit was much too short, but I didn't want to leave Raquel alone for too long. I'll get down again soon, I hope.

Happy and I figured out the sleeping/tent situation that night and were much drier and warmer. We both slept better and woke to another glorious day. I rode out again with a bigger group and Happy enjoyed herself sunbathing and just relaxing as she deserved to do. Then we had a great surprise when my husband Michael and Verbal showed up that afternoon! Nobody enjoyed the water and sand as much as my goofy yellow dog.

I got Michael out to the beach and up on Raquel-and he had a great time! He doesn't ride much, but he felt so much more comfortable on her and was soon galloping down the beach like a pro.

You would think that was a full enough day, but no. One of our meetup members, Phil, is very involved with jousting and he brought his authentic suit of armor ( he said it weighs about 100 pounds!) and costume for his horse. Now, isn't a knight in shining armor exactly what dreams are made of?

We had another dry, warm night, time for a quick ride on the beach Sunday morning, then packed up and headed home. It was over much too quickly, but I know Raquel was exhausted even though she would have gone on forever. I'll never forget this trip and all the people who made my dream possible. My terrific staff and our relief doctor took great care of my patients and clients while I was away. Happy was a true friend-what more can I say about that? Michael surprised us by bringing Verbal and joining us for the weekend. And the wonderful meetup group who suggested the trip, made recommendations of what to bring for us newbies at horse camping, and Michelle and John for hauling my big horse all the way down to the Oregon coast. Dreams really do come true.

Peace,
DrReneigh

Telling Time Without A Watch

We were nearing the end of another busy day at the hospital. Dirty towels and surgical drapes were piled high in the laundry basket. Some instruments were soaking in the bucket of disinfectant and others were finishing up in the autoclave, getting sterilized for tomorrows procedures. Patient charts were seperated into different piles, some for the nurses to make follow up calls, others for me to complete writing my medical notes and plans for patinet care. But one of the tell-tale signs that the day was coming to a close was the presence of Noodles and Twitchi, our hopsital cats. Without fail, every evening starting around 4:30 or 5, they make there way out from where ever they had been hanging out, usually working pretty hard, sleeping on a cat post or in one of the receptionist's chairs. Then they oh so patiently just sit-and stare-and wait. It is kind of creepy, actually, like the gathering of the birds in Alfred Hitchcocks movie. There is no mistaking what they want-come on humans-don't forget us (as if we ever have!) It is dinner time!

Anyone who has ever had a pet knows that they can tell time-no watch or clock needed.
We can say they have a "biological clock" or an "internal clock." It actually is an anatomical site within the animal's hypothalamus, an area of the brain directly above the place where the optic nerves cross. Composed of about 20,000 neurons, this area is known as the suprachiasmatic (above the cross) nucleus. It takes in variations in the available light from the retina, (the structure at the back of the eye) then transmits this information to the pineal gland. The pineal gland is a small, cone-shaped organ in the brain of most vertebrates that secretes the hormone melatonin. It is also called epiphysis, or pineal body.

There is a complex process allowing this transmission. Genes are encoding proteins and these genes will then regulate the functions of the cells of the pinel gland. This is when the cells start secreting the melatonin hormone. Once in the bloodstream, melatonin peaks in the daylight hours and ebbs at night causing wakefulness and sleepiness.

The circadian system is the total of all these neurons, their cells and the proteins and hormones they secrete. The system is not dependent on light and dark cycles, however. That is why animals can re-set their internal clocks as long as the new pattern is fairly regular and sufficiently important. In the case of Noodles and Twitchi-putting food in their bowls is plenty important!

Dogs and cats aren't the only ones who have these internal clocks. Species as diverse as fruit flies, humans and birds have circadian rythyms, and they don't have to be exactly one day long. (In Latin, "circadian" means "approximately one day.") Two examples are the heat cycles of domestic dogs, which usually occur about twice a year, and the menstral cycles of human females occuring approximately every 28 days.

So tomorrow night when your critters start circling up in the kitchen or come over and lay down near their food dish-raising those expressive eyebrows at you (as if you really don't know what they could want-we are dumb humans after all) , remember how complex a thing this circadian rythym process really is-and why when Noodles and Twitchi get ready to "retire" from their very busy jobs here, they probably don't need that gold watch. They do just fine with their internal clocks.

Peace,
DrReneigh

Jesse is Being an Ass

If it isn't one thing, it's certainly another-that sure is true around my house, what with all the critters we have. From pulling Stella out from under the bed to give her asthma medications, to making sure Verbal gets her arthritis drugs and supplements every day, and more recently chasing a ticked-off rooster so I can dose him with some pain meds-gee, what more do I need to medicate? I shouldn't have asked that question. Can anyone say limping donkey?

Yep, Jesse, my very furry, long-eared donkey is very lame, barely putting any weight on his left hind leg. I am pretty sure it is due to an abscess in his hoof-he seems to get one every year. Donkeys or burros are supposed to have really tough, hardy feet. Well, I don't know if it is all the mud we have (really not too bad considering all the rain here) or the rocks, his particular conformation or what, but Jesse's feet are just prone to these infections that occur within the hoof.

A hoof abscess can be defined as a localized accumulation of purulent exudates (pus) located between the germinal and keratinized layers of the epithelium (hoof capsule), most commonly subsolar or submural. I have seen these occur in horses secondary to nails from shoeing, but Jesse has never had shoes on his feet, and the last trimming he had done was over a month ago. Of course, the same thing can happen if a horse is punctures by a nail or other sharp object. Other abscesses occur after a deep bruise to the sole, usually from a stone wedged in the sulcus or groove adjacent to the frog tissue. The frog is the softer triangular wedge of tissue that acts as a pump in an equine leg. Often referred to as an additional heart, the 4 frogs (one in each foot) help the circulatory system, literally pumping blood back up those long legs to the lungs so it will get oxygenated again. Breakdown at the junction between the sole and wall as happens in white line disease or a simple crack in a hoof wall can predispose a foot to abscessation.

Understanding how an abscess forms can help in the understanding of how to best treat the often very painful condition. Bacteria will enter at the puncture, bruise, nail hole or white line defect, usually at the sole-wall junction at any point around the foot. As the horse walks and puts weight on the foot, dirt and other foreign matter push into the tract made by the bacteria. Once inside the hoof, the body's defense mechanism sets off a reaction called inflammation-this is ultimately what causes the heat, swelling and pain. The bacteria continue to grow in this environment, and white blood cells migrate to the area to help fight the infection.

Enzymes are released from the bacteria and this causes the hoof tissue to melt or liquify, turning into the blackish/gray "goo" associated with abscesses. The body tries to wall this off with a thin capsule, forming the abscess capsule. It can get very tight as the bacteria continue to reproduce within, resulting in more inflammation and thus more pain. It usually only takes about 3 to 5 days from the initial "insult" for clinical signs to occur, so if your farrier accidentally misplaces a nail or your horse (or donkey) gets a puncture from some other cause, treating with an antiseptic for a few days might ward this off. Of course, we often never know about the puncture or bruise that caused the abscess, as in Jesse's case. If I had, I would have loved to have prevented this apparent excruciating pain-and my need to fight with yet another of my own own butthead patients.

Jesse lets me know he has an abscess by showing up extremely lame in the affected foot. The lameness can be pretty sudden as his tend to be, and can vary from subtle early on to non-weight bearing as the condition progresses. It is often possible to palpate a digital pulse near the fetlock, stronger on the side of the foot where the abscess is located. Overall, the affected foot is usually warmer due to the inflammation, and if long-standing, the entire pastern or fetlock may become swollen from the disease or from disuse. We often use hoof testers to locate exactly where the abscess is, although some horses are sensitive in the entire foot making you need to rule out laminitis or founder, a severe bruise or even a fracture of P-3, the coffin bone itself.

Treating hoof abscesses requires first and foremost good drainage. An opening should be made that is big enough to allow good drainage and won't heal closed too quickly, but also won't be so big that it causes more problems. Under no circumstances should an abscess be approached through the sole. Dirt and manure and other foreign matter will just pack into a solar drainage hole, making it ineffective or even worsen the condition.

When an abscess is localized with the hoof testers, a small tract is often found in the sole-wall (white line) junction. If it is not visible or has closed up already, a poultice can be applied in an attempt to soften the area and break it open again. Animalintex, available at feed stores or veterinary supply stores, is a great product, as are epsom salt soaked sponges. Full foot soaks, once the norm for so many foot conditions, are now discouraged as they can really soften and weaken the integrity of the hoof wall.

The drainage tract is followed within the white line using a thin small loop knife, a 2 mm bone curette or other suitable probe. Gray/black pus is the reached when the "belly" of the abscess is reached and this area is cored out carefully.

A small opening is all that is necessary to obtain proper drainage. This can be determined by placing thumb pressure on the solar side of the tract and observing more drainage being expressed or a bubble at the opening when pressure is applied. Care should be taken to avoid exposing any corium, as it will invariably prolapse through the opening, prevent closure of the tract and create an ongoing source of pain.

The draining tract should be kept soft and drainage promoted. The application of an Animalintex or epsom salt poultice that has been soaked in hot water can be applied for the first 24 to 48 hours. The whole foot, including the coronet band, should be incorporated into the poultice for best results.

The relief is usually pretty immediate. Once the pressure is relieved, most animals will bear weight again, and if the infection is controlled, all lameness should be resolved in just a few days. It is often best to keep the foot bandaged to prevent the introduction of more bacteria and debris into the newly opened drainage site, and antibacterial dressings can be applied to help speed up the healing. Betadine or iodine solutions are effective and inexpensive.

I rarely put these patients on systemic antibiotics as it was mentioned above that these infections are usually walled off from the body and therefore inaccessible to the bloodstream. Pain relief medication such as phenylbutazone is very welcome, however. Jesse, of course, hates his bute, even the apple-flavored paste, and isn't making this process very easy. Be sure tetanus vaccinations are up to date as the tetanus organism thrives in soil and would love this type of wound.

Some people actually allow abscesses to "run their course," allowing the infections to follow the path of least resistance and eventually rupture up and out at the coronet band. This seems like a cruel thing to do, making an animal wait in extreme pain for this process to occur, and it can leave the hoof much weaker and prone to repeated abscesses in the future.

So, today after work, my terrific horse shoer, Fred, came over and helped me wrestle with my problem child. Jesse really does love most people, but he and Fred have always had a bit of a love/hate relationship. Fred doesn't take any of Jesse's shenanigans, one time even trimming his feet laying down when Jesse threw a fit and decided to fall down to the ground in protest. He has since learned it doesn't do a darned bit of good; Fred will win every time, darn it!

Jesse was in fine form tonight, though, and oh so quick with that sore hind foot. While Fred got ready with the hoof knife and nippers, I got out the drugs. It was no fun finding a vein in which to give his drug through all that winter hair of his, and he proved just as stubborn metabolically-his drug dose probably would have stopped an elephant but Jesse barely hung his head. It was enough for Fred to quickly cut into that hoof, find the abscess and provide some good drainage before Jesse decided he had enough and found his aim again. He could barely walk-he looked like quite the drunk donkey-but I wouldn't have trusted that back foot one iota. I snuck some bute between his lips much to his chagrin and let him stagger off to commiserate with Raquel. He's going to be just fine.

Prevention of hoof abscesses is achieved through proper hoof care and centers on promoting a strong, solid sole-wall junction (white line) that resists penetration by debris. Hoof abscesses are less likely to occur when a solid sole-wall junction (white line) is maintained.

Excessive toe length increases the bending force exerted on the toe, leading to a widening and weakening of the white line. Other conditions that cause mechanical breaks or weakness in the continuity of the white line are hoof capsule distortions (long toe-under run heels, excessive toe length, heels too high or a club foot, sheared heels), hoof wall separations (white line disease, seedy toe) and chronic laminitis. Excessive moisture or dryness, and the extreme back and forth from one season to the next, may also contribute to weakness in the white line. I really think this is Jesse's problem, as we do a pretty good job keeping his feet trimmed and he has never had white line disease, laminitis or any of the other hoof pathologies mentioned.

So, thanks to Fred, Jesse is all doctored up for the evening. I chased down Viggo and pulled off that last straggling bandaid from his surgical site. It is healing well and he is crowing and herding his ladies in the yard-I think he is doing well, too. Verbal got her dinner with her medications for arthritis mixed in. And I just popped Stella her prednisolone tablet to help calm her inflammed airways until her inhaler arrives later this week. Whew! It feels like a vet hospital around here. It's a darned good thing that Bill the emu is healthy-I better knock on wood!

Peace,
DrReneigh

Viggo Can't Help Being a Boy

Poor Viggo. He's just being a boy, and after all, that's what he is. But boy + chicken = ROOSTER, and when that is accompanied by an attitude that won't quit, well, something has to change. He is a handsome thing-and he certainly knows it. We have a whole slew of chickens, his little band of girls, and I'm not sure if he thinks he is protecting the ladies or if he is just being a butt head (much more likely) but he has started attacking us lately-and it hurts! Viggo hurls himself up and slams his 6+ pounds against your thigh or whever he can contact-and then he rakes his evil spurs against you. The spurs are actually bony appendages on the legs of roosters. They are very sharp, and yes, they sure can do some damage. I had a bruise that lasted for a week after his last unexpected attack. I'm getting pretty good about watching for him now, and (don't tell the animal cops!) he has received a few well placed kicks in the hind end when he was caught flying towards me. I even bring Verbal with me when I go to feed the chickens-she loves to chase them and her favorite sport is tumbling them head over heels (do chickens have heels?) as they squak and flutter. She has never attacked or hurt one-she just loves the chase and I'm sure she likes the noise they make. But Viggo doesn't back down, from me or from Verbal, and I'm afraid he is going to hurt her or maybe some unsuspecting visitor to my little farm one day.

So today our hospital sounds like a barnyard at 4 am-a very perturbed rooster is crowing at the top of his lungs-and won't shut up! Clients this morning have a very puzzled look on their faces, and everyone has smiled when we told them yes, we treat roosters, too, not just cats and dogs at this hospital. Noodles and Twitchy, our hospital cats, are just fascinated with this giant bird. They know they are supposed to be the predators, but Viggo stands taller than them and that voice-wow. Twitchy, especially, is going to need some time to get used to this.

The plan for Viggo was simple. We were going to place a mask over his beak and administer a gas anesthetic and oxygen mixture. Birds usually fall asleep very quickly with little struggle due to their very rapid metabolism. They generally have large tracheas, so we should be able to place an endotracheal tube for better anesthetic safety. We'll monitor him as we do any patient, and maintaining body heat is particularly important. Then I'll basically amputate those spurs or extra "toes." I had asked an avian specialist about this procedure and he said there shouldn't be much bleeding, but I could place some light wraps for a day or so if there was. He told me meloxicam would be fine for post-op pain relief and gave me some doses appropriate for a mature rooster. I'm not looking forward to chasing down that darned bird every day to stuff meds down his throat, but I will if I have to. Oh joy.

Here is Viggo getting his pain meds. He was a good boy for his medications, so maybe it won't be such a chore after all.

Well, the procedure itself was pretty quick, but I don't know what the specialist was talking about-those spurs bled like a son of a gun! I had to place some pretty tight little wraps over the surgery sites to get the blood to stop. Viggo started to pick at the wraps when he woke up and was kind of dancing a bit-I felt like the pain medication wasn't enough for him, so gave him an extra dose. That seemed to do the trick-he stopped dancing in his kennel and left the wraps alone after that. Pain control is important for all of us, even roosters.

So, we'll see how this goes. Taking away his weapons should at least make us safer around the barn yard, but maybe it will humble that cock-o'-the-walk, too. I can hope!

One other funny thing happened as a result of Viggo being in the hospital today. A sweet patient named Roarie, here for her own surgery and recovering in the cage right next to Viggo, was barking and howling and basically calling back and forth to him all day. It really sounded like she was trying to crow just like he was! Her owners were great about it, laughing when they heard her as they came to pick her up. I sure hope they are still laughing when she starts crowing at the 4 am wake-up call!

Peace,
DrReneigh

No More Tears for Tucker

Tucker is a bouncy, happy Springer Spaniel puppy that didn't actually look very happy before his surgery yesterday. ( I didn't get a picture before surgery, darn it. I'll try to remember when he comes in for his suture removal.) He was constantly tearing or crying in one eye-and certainly not because he had anything to be sad about. This puppy has great owners and when we pointed out the tears during his physical exam last month, they promised to watch the eye and note any changes. I showed them how Tucker's lower eyelid was rolling inward, a painful condition called entropion, which causes the eyelashes along the border of the lid to constantly rub on the sensitive cornea of the eye.

Entropion can have a genetic cause, and Springers are one of the breeds predisposed to the condition. Other breeds commonly affected are Boxer, Bull Mastiff, Cavalier King Charles Spaniel, Chesapeake Bay Retriever, Cocker Spaniel, English bulldog, Golden Retriever, Great Dane, Irish Setter, Labrador Retriever, Poodle, Pug, and St. Bernard. Chow Chows and Shar Peis have all those extra wrinkles in the skin, so they can have very severe forms of the condition, and left untreated, entropion can cause painful ulcers and erosions on the cornea that results in scarring and affects vision. Those pets with the heritable form of entropion should not be used for breeding. Entropion can also occur as a secondary condition resulting from scarring of the eyelid, infection, corneal spasms and pain, trauma, or nerve damage. Sometimes it happens after the eyelids lose their normal neurologic function.

Tucker was fortunate because only one lower lid was affected-entropion can often affect both eyes and both upper and lower lids. When we examined his eye, we applied a stain called fluorescein on his cornea. If there had been any defect on his cornea such as an ulceration from chronic eyelash rubbing, the stain would have glowed bright green when a black light was shown on the eye. Tucker's cornea was fine so far, so correction of the eyelid malformation should prevent that damage and subsequent pain.

Surgery is the only way entropion can be permanently corrected-essentially plastic surgery for dogs, although it is not an elective or cosmetic procedure. The hair is surgically clipped around the eye and the skin is scrubbed, protecting the delicate eye tissue. Then the excess skin is "pinched" between several hemostats, taking gradually bigger bites until the eyelid everts or rolls outward to a more normal position. We don't want to encorporate too much skin in the hemostats or we can cause ectropion, the opposite condition in which the eyelid is rolled outward. I really like the pinch technique because it allows me to see how the the anatomy of the lid will change after removing the encorporated tissue. After removing the hemostats, the pinched skin stays standing up; this is trimmed away (called a blepharoplasty) and the resulting skin incision is sutured closed with very tiny, silk sutures. Most dogs need to wear an e-collar or satellite dish on their heads to prevent rubbing the surgery site as it heals. Stitches are usually removed in 10 - 14 days and once the hair grows back, you usually can't see much of a scar at all.

There isn't much problem with recurrance of the entropion except for in the very wrinkled, extra-skinned dogs like Shar Peis. Some surgeons may take a conservative approach to the initial surgery, only taking a small amount of skin during the blepharoplasty. They believe they can always go back to take more skin at a later date if the lid needs to roll out more, but it wouldn't be possible to put it back if too much was removed the first time. Some dogs require systemic or topical antibiotics and all should have pain relief medications for at least a few days post op.

Tucker's surgery went very well. I believe the repair resulted in a more comfortable eye for him, and I know his owners will be watching him for any signs of problems. He also got neutered that day, so he definitely got some pain relief medications and a nice big e-collar. When he recovers he can go back to looking as happy as he actually is-no more crying by Tucker!

Peace,
DrReneigh

A Horse is a Horse, Of Course, Of Course

I've been preoccupied with some extra-curricular things lately so have been very neglectful of my blog. I just put a nice deposit on a beautiful saddle for my gorgeous horse, Raquel. Michael, my husband, had been making some noises like he wanted to start riding her, so I wanted to do all I could to encourage him. He wouldn't feel comfortable riding in my "funny" little English all-purpose saddle. I like that one because it is MUCH lighter, and lifting a heavy saddle way up on her back isn't fun. My old roper saddle I use when other people ride her is, well, old. I have tried to take care of it, but the leather is cracked (I have newer leather for the latigos and cinch so it is safe, just not very pretty....) and it kind of lists to one side on those longer rides, so you constantly need to shift your weight over to balance things out. It was just time to retire it.

I found quite a few Western saddles that would work just fine-but boy are they expensive! I'm generally not one for buying new things for myself at all, shopping for most of my clothes and all at stores like Value Village or Goodwill-thrift and second hand stores. Don't get me wrong, I usually find pretty nice, brand name clothes there. I just hate to pay full price for anything. I'm wearing my work dresses around jumping, slobbery, muddy, shedding dogs and cats, so I just don't want to spend tons of money on things that could easily get ripped or pooped or peed on. Well, I decided to splurge and get Raquel a nice new saddle this time-she's worth it, and so am I! But I wanted to be smart about it, especially with this crummy economy right now. So no credit for us. Lay-away would work just fine.

Even though she is a pretty big horse, Raquel isn't too difficult to fit for a saddle. But since I was planning to spend so much, (for me, that is-I know other people can spend many thousands of dollars on much fancier saddles!) I wanted to be certain of that fit. I arranged with a local tack store to take a few saddles home to try on her, being very careful not to get them muddy or hairy-quite the feat in this Spring season. She isn't anything BUT mud and shedding hair right now! I wrapped some plastic grocery bags over my feet and put saddle blankets on her and we took a few short rides around the neighborhood. Now I sure didn't want or need anything too fancy-we aren't going to be showing any time soon. No silver or lots of tooling (carved designs in the leather.) I was looking for something that fit her, fit me and Michael, was comfortable to sit in, and also looked nice.

I think I found a really nice one-I couldn't believe how comfortable it was! It has a gel seat and a flex-tree, so it should be just as comfortable for Raquel as it is for me. I'll be sure to get pictures when I actually get the saddle....you see, my thrift store nature came out after all. I took the manufacturer and model number and went searching on the web. I found the exact saddle, only it was a black one-perfect for my solid black horse!-for sale on Craigslist. The seller said she had only used it 3 times, so it was essentially new, and would save me over $800! How could I pass up such a deal? I felt bad about not buying it from the local tack store as I do like to spend my money locally, but I assured them I would be in frequently for all the miscellaneous things you always seem to need or just plain "have to have" when you are a horsey person. The saddle is in the mail as I type this, coming from New Hampshire!...I am very excited and this saddle is so nice that I might be converted to riding in the Western saddle more often! I just don't buy big things for myself very often, can you tell? I wonder if everyone gets this excited when they buy big toys? I hope so!

Speaking of Raquel, I have been trying to get her out riding more often lately. I joined a meet-up group of fellow horse lovers and we are actually going on a camping trip next month to the Oregon coast. It is a dream come true mixing two of my favorite things-horses and beaches! I sure hope we have some nice weather. It will probably be the first time my friend Kristen and I will be able to ride together-can you believe that? Neither of us has a trailer, so even though we live fairly close, we can't get our horses together-bummer. This camping trip will be a great thing since I hardly ever take time off work. I think everyone is saying "it is about time!" So, I am riding my big girl around the neighborhood a couple times a week and I just signed up for some riding lessons to work on better communication with her. I am really the only one who has ever ridden her regularly, starting her as a baby and all. It sure won't hurt to have that extra help to better both of our skills and to get us both into shape after a much too long winter.

I really like the folks in the meet-up group. It is the largest and most active equestrian meet-up in the world-right here in Snohomish/King counties! So far I haven't been able to ride with others, but we have frequent meet-ups where we have potlucks, sell our used tack and swap information. I'm the "animal health coordinator" so feel it is important to educate the group on all things veterinary-first aid, normal and abnormal vital signs, how to wrap leg bandages, etc. We are even putting together a binder of handouts on these topics for future use. I'm working with my staff at the hospital to put together an equine first aid kit, complete with bandaging materials, a stethoscope and thermometer and other things important for a horse owner to have on hand in case of an emergency.

So this blog will have at least a little bit of a veterinary topic today, here are the horse vital signs it is important to be familiar with. If your horse's numbers are significantly out of range, CALL YOUR VET!

Body Temp: 99.5 - 101.3 degrees F
Pulse rate: 28 - 45 beats per minute
Respiration rate: 10 - 14 breaths per minute

Take the temperature

• Lubricate the thermometer with petroleum jelly, K-Y jelly or just spit on the end. It must be wet for good contact with the rectal mucosa.
• Attach a string to the end of your thermometer. (They have been known to fall into bedding or even get "sucked" into the rectum.)
  
• Tie a clothespin to the other end of the string so you can attach it to your horse’s tail while you’re taking his temperature.
• Approach the horse from the side, and do not stand directly behind him.
• Raise your horse’s tail and insert the thermometer into his rectum.
• Wait at least 1 minute, then read the thermometer.
• Digital thermometers are often very quick and accurate.
  

Find the Pulse

• Use your fingers or a stethoscope to find your horse’s pulse under his chin or on the left side of his barrel, just behind his left elbow. It can also be located at the temple.
  
• Each “lub-dub” is considered one beat.
• Record the rate for 15 seconds and multiply by four to get your horse’s heart rate.

Check Breaths

• Watch your horse’s chest move in and out, or cup your hand over his nostril and feel the air come out.
• Use your stethoscope to listen to the breaths as the air travels across the trachea when he inhales and exhales. It should sound clear and consistent.
• Note the characteristics of your horse’s breathing. Are the breaths shallow or deep? Are there any abnormal sounds like squeaking or roaring?

A horse’s daily water requirement varies from 5 to 20 gallons, depending on environmental temperature, workload, production state and feed intake. Providing clean, fresh water is a top priority for horse owners, especially if you are traveling.

The vital signs listed are for RESTING horses. If they are nervous or excited or just finished exercising, these will vary. Even just the sight of a thermometer or stethoscope can freak out some horses, so take this into consideration.

Happy trails, everyone!

Peace,

DrReneigh